Chapter 47- Organ and Hematopoietic Stem Cell Transplantation My Nursing Test Banks

 

1.

Selecting the ideal candidate for transplantation is an intricate process. To evaluate a patients suitability for transplantation, a comprehensive analysis on the patient is performed that includes which of the following types of assessments? Select all that apply.

A)

Multisystem

B)

Physiological

C)

Psychosocial

D)

Single donor system

2.

Which of the following general assessment criteria guide the selection for transplantation? Select all that apply.

A)

Age

B)

Presence of infection

C)

Presence of malignancy

D)

Health insurance

3.

Which of the following organ-specific criteria for transplantation are taken into consideration?

A)

ABO typing

B)

Transfusion history

C)

Gynecological examination

D)

Eye examination

4.

The critical care nurse knows that determination of compatibility in transplantation involves the evaluation of two major antigen systems. A mismatch in compatibility may cause an immediate reaction leading to organ loss. The primary determinant for solid organ transplantation is which of the following?

A)

ABO grouping

B)

HBO grouping

C)

A and B antigen matching

D)

HLA grouping

5.

Which of the following are paramount procedures that the critical care nurse ensures are complete during the preoperative phase for the patient undergoing organ transplantation?

A)

ECG

B)

Complete dialysis within 48 hours

C)

CT of the head without contrast

D)

Venogram and arteriogram

6.

The nurse assesses a kidney transplant patient in the ICU immediately following surgery. Which of the following assessments are paramount in the care of the patient? Select all that apply.

A)

Vital signs

B)

Central venous pressure

C)

Patency of urinary catheters

D)

Blood sugars

7.

During the immediate postoperative phase, the critical care nurse focuses on hemodynamic stability. Blood products should be leukocyte reduced to avoid introduction of CMV. CMV causes which of the following?

A)

Death

B)

Hyperkalemia

C)

Shift of oxyhemoglobin curve to the right

D)

Immunoadsorbent assays

8.

Some degree of postoperative renal dysfunction is common due either to hepatorenal syndrome or hypotension during surgery. In addition, some immunosuppressive medications are nephrotoxic. This can affect which of the following?

A)

Fluid and electrolyte balance

B)

Increased cardiac output

C)

Amount of dialysis treatments

D)

Retransplantation

9.

A patient 30 days postoperative after allogeneic hematpoietic stem cell transplant presents with adenovirus and Candida infection. The critical care nurse suspects which of the following?

A)

Acute graft-versus-host disease

B)

Chronic graft-versus-host disease

C)

Neutropenia

D)

Stem cell rejection

10.

Long-term care focuses on monitoring the patients progress and adherence to the health care regimen. In solid organ transplant recipients, a major cause of graft loss in the long term is failure of patients to adhere to which of the following?

A)

Medication regimen

B)

Dietary requirements

C)

Follow-up appointments

D)

Financial requirements

11.

A patient is being evaluated for a solid organ transplant. If the patient is found to be eligible for a transplant, which of the following would the nurse expect to find?

A)

Age less than 65 years

B)

Presence of active inflammatory process

C)

End-stage organ disease refractory to other treatments

D)

Able to reach full life span without transplant

12.

A patient with end-stage organ failure is being evaluated for an organ transplant. What factor is most likely to be a contraindication for transplant?

A)

Age 30 to 55 years

B)

Absence of acute or chronic infection

C)

Cannot afford the cost of medications after transplant

D)

Is receiving maximum doses of organ support medications

13.

The patient is being evaluated for compatibility for a solid organ transplant. What congruency between donor and recipient is the primary requirement?

A)

B and DR locus

B)

HLA matching

C)

ABO blood grouping

D)

White blood cell (WBC) match

14.

During evaluation for compatibility with the donor, a potential organ transplant recipient undergoes HLA matching. When explaining the importance of this test to the patient, what is the best rationale for the nurse to use?

A)

This is simply a routine part of compatibility testing for all organs.

B)

The higher the number of matching antigens, the lower the risk of rejection.

C)

This test is used to ensure that the donor does not have an active infection.

D)

HLA testing is part of the ongoing research into organ transplant success.

15.

A patient is awaiting a stem cell transplant. What donor is most likely to have the best HLA and MLC matching?

A)

Not related, with same ABO group

B)

Sibling of same gender

C)

Any blood relative

D)

Nonrelated donor of either gender

16.

A patient has experienced brain death after a head injury and the family has consented to organ donation. In this situation, who does the nurse now recognize as managing the care of that donor?

A)

Attending physician

B)

Intensive care physician team

C)

Registered nurse from organ procurement organization

D)

Pathophysiologist from the medical examiners office

17.

The nurse is caring for a patient who has just received a kidney transplant. What nursing assessment finding would be most indicative of development of urinary drainage blockage?

A)

Swelling over the graft site

B)

Decrease in serum creatinine

C)

Sudden drop in hourly urine drainage

D)

Increase in serum sodium

18.

The nurse is caring for a patient who has received a liver transplant. The patients blood pressure is dropping and there is increased bloody drainage from the Jackson-Pratt drains at the abdominal incision. What is the most important nursing action?

A)

Administer intravenous fluid bolus.

B)

Continue close observation and monitoring.

C)

Notify the surgeon.

D)

Milk the Jackson-Pratt drainage tubes.

19.

A patient with end-stage liver failure has received a liver transplant. During the postoperative care phase, the nurse monitors the patients oxygen status closely. What condition may interfere with the use of peripheral pulse oximetry in this patient?

A)

Metabolic acidosis

B)

Severe jaundice

C)

Normal body temperature

D)

Clubbing of fingernails

20.

After a liver transplant, what nursing assessment best indicates that the transplanted liver is functioning?

A)

Increased INR ratio

B)

Increased aminotransferase levels

C)

Unstable serum glucose levels

D)

Increasing bile drainage

21.

A patient has had a heart transplant using the standard atrial cuff technique. Based on the use of this surgical technique, what cardiac monitor reading does the nurse most expect?

A)

Third-degree heart block with ventricular rate 80

B)

Two P waves for each QRS complex with one in disassociation

C)

Two independently rhythmic QRS complexes

D)

Ventricular pacing stimulus followed by a QRS complex

22.

An adult patient with a heart transplant develops severe bradycardia. The patient also had worsening hypotension and a deteriorating level of consciousness. What is the priority nursing action?

A)

Administer intravenous atropine.

B)

Administer intravenous epinephrine.

C)

Apply a transcutaneous pacemaker.

D)

Place the patient in reverse Trendelenburg position.

23.

A patient who received a kidney transplant 2 months ago is having an episode of acute rejection. The patient expresses fear that his new kidney will not survive. What is the best rationale for the nurses response?

A)

Cytotoxic T cells damage the donor organ by secreting lysosomal enzymes.

B)

Acute rejection is the most common type of rejection.

C)

Acute rejection is the type most likely to respond to immune suppression.

D)

Acute rejection occurs when donor organ antigens trigger helper T cells.

24.

A patient who has received a solid organ transplant is experiencing chronic rejection. What symptoms does the nurse most expect?

A)

Lack of T-cell activity or increase

B)

Evidence of deteriorating organ function

C)

Evidence of immune suppression

D)

Negative antigenantibody reactions

25.

A patient who is immunosuppressed after organ transplant has acquired an infection. What symptoms does the nurse most expect?

A)

Fever above 101 F

B)

Increase in the percentage of WBC bands

C)

Subnormal core body temperature

D)

Decline in absolute neutrophil count

26.

A patient who has received an allogenic stem cell transplant has developed graft-versus-host disease. What symptoms does the nurse most expect?

A)

Diminished lymphocytes

B)

Elevated liver function tests

C)

Absence of active T cells

D)

Very high fever

Answer Key

1.

A, B, C

2.

A, B, C

3.

A, B, C

4.

A

5.

A

6.

A, B, C

7.

A

8.

A

9.

A

10.

A

11.

C

12.

C

13.

C

14.

B

15.

B

16.

C

17.

C

18.

C

19.

B

20.

D

21.

B

22.

C

23.

C

24.

B

25.

B

26.

B

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